ISLAMABAD: A letter written by the Federal Investigation Agency (FIA) to the Drug Registration Authority of Pakistan (Drap) has revealed that companies selling stents in Pakistan for Rs150,000 had mentioned the purchase price of the device in the import documents to be 20 to 150 euros (Rs2,500 to Rs18,000). Moreover, one company was importing the same stents for $350, which raised questions if it was involved in ‘transfer pricing’ (sending foreign exchange out of the country by over-pricing). The letter asked Drap to fix the prices of stents at the earliest.

When contacted, Drap Chief Executive Officer Dr Aslam said not only he would ensure the formulation of a pricing policy within a month but would also check if offshore companies were being used for the ‘transfer pricing’.

The FIA through the letter (available with Dawn) written on Feb 16 informed Drap that in a government hospital in Lahore private individuals were selling stents at the rate of Rs55,000 to Rs150,000 each.

Companies selling stents for Rs150,000 purchased the devices for Rs2,500 to Rs18,000 as mentioned in their import documents

“In routine, the hospital administration purchased stents through tenders for Rs39,900 to Rs51,880. However, in emergency cases these were purchased by the hospital for Rs145,000 per piece locally,” the letter added.

Under the local purchase, hospitals buy devices and medicines without tenders in case of an emergency. Mostly, local purchases are made when VIPs are admitted to hospitals. The letter said the customs records showed that one company imported 585 German stents at a cost of 20 Euro per piece. The same company also imported stents of the same brand costing 30 to 120 Euro. However, another company showed that it imported drug eluting (medicated) stents for $350 per piece.

An official of the Ministry of National Health Services (NHS) requesting anonymity said as companies were not allowed to send foreign exchange out of the country, some of them quoted over-prices to send foreign exchange abroad. The National Accountability Bureau (NAB) should look into the matter, he said. The FIA letter also said when the director pricing Drap was approached he stated that not even a single case for the fixation of prices had been referred to him by the director registration.

The FIA said the practice on the part of Drap had seriously affected the patients. Even the Drug Pricing Policy 2015 did not fix the prices of stents and other related devices/drugs.

As the stents have been declared drugs, its prices should be fixed to safeguard the interest of the patients, the letter said. The Senate Standing Committee on NHS on Feb 10 also directed Drap to devise a pricing policy for stents within a month and submit it to the committee.

Dr Aslam told Dawn that he would check if transfer pricing was being done during the import of stents through offshore companies. Moreover, it would also be investigated from which country the stents were coming.

“Considering the current circumstances we have decided that the prices of stents will be fixed as a consensus has been built after consultative meetings with the provinces,” he said.

Stents are small, expandable tubes that treat narrowed arteries in the body. In people with coronary heart diseases caused by the built-up of plaque, stents can open narrowed arteries, reduce symptoms such as chest pain and help avoid a heart attack. Last month, not only a huge amount of unregistered stents worth over Rs250 million were recovered from Mayo Hospital Lahore but it was also revealed that in some cases patients were falsely told that stents had been fixed on their body.

The Supreme Court of Pakistan took a suo motu notice of the matter and has been pushing Drap and other stakeholders to ensure the quality of stents at affordable rates.

Moreover, it was revealed that there was no mechanism for the sale of stents due to which instead of selling through medical stores representatives of the companies remained present in the cardiac centres of hospitals to sell the stents to patients without giving them any authentic receipt. As a result, the patients do not know what type and quality of stent is fixed in their arteries.

Published in Dawn, February 19th, 2017